1. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 1 Vermont Nurse Internship Project Susan A. Boyer, M.Ed., RN, Program Director www.vnip.orgwww.vnip.org vt-nurses@earthlink.netvt-nurses@earthlink.net

2. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 2 Internship Model Founded upon Coalition between Education, Practice & Regulation Supported by Director position and stakeholder groups Rooted in Preceptor delivery process Explore the website – www.vnip.org for further detail, guidelines & explanation.www.vnip.org

3. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 3 Unique Aspects of VNIP Model Collaborative effort inclusive of Education, Regulation & Practice (all HC settings) Framework/tools developed for use in multiple agencies across the continuum Competency development/assessment considers critical thinking, human caring, leadership and management skills as being of equal importance as the tasks & procedures (based on the COPA model)

4. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 4 Other unique aspects Focus on preceptor development Research and theory based Mixed audience inclusive of allied health team Teaching preceptors to foster C.T. skill development & evaluate performance outcomes Statewide standardization of preceptor and intern development framework and curriculum (including competence assessment)

5. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 5 What we have learned Preceptor development and support Clinical Coaching Plan - Development of Critical Thinking Preceptors Interns Clearly defined expectations Standardized performance outcomes (COPA)

6. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 6 Preceptor Development Teaching how to teach how to develop critical thinking in others Protector role Evaluator – competency validation

7. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 7 Clearly Defined Expectations For both intern and preceptor COPA model http://nursingworld.org/ojin/topic10/tpc10_2.htm http://nursingworld.org/ojin/topic10/tpc10_2.htm Eight essential duties Defined in specific measurable terms Consider critical thinking skills What does a nurse do?

8. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 8 Clinical Coaching Plan Teaching plan &/or action plan Principles of teaching and learning Adult learning and personal learning styles Experiential learning – action based Specific measurable outcomes (COPA) Specific instructional strategies Concrete C.T. development tool

9. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 9 Outcomes Start with the end What are your goals ? Why change ? How will you know that you have succeeded? How to measure it? Tools, process, outcomes

10. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 10 VNIP Data, Outcomes, and implications of the pilot 48% of Interns recruited from out of state schools and/or residence Retention – FAHC tracking 1999 Pre-Internship rate was 75% With the internship, the rate rose to 93% of new grads that completed

11. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 11 Satisfaction Survey – Transition to practice strongly disagree strongly agree

12. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 12 Outcomes Position Vacancy rate Consistently 20% & higher prior – currently 0% No recruitment or advertising costs Nursing students – asking for positions after program completion

13. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 13 Outcomes Nursing literature reports that the inability to handle the intense working environment, advanced medical technology, and high patient acuity results in new grad turnover rates of 35% to 60% within the first year of employment. (Beecraft, Kunzman, & Krozek, 2001) VNIP turnover rate = 6% for new graduates completing the internship

14. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 14 Workplace Culture Support and nurture Value learning Value individual Time for questions, learning, teaching vs. Insanity

15. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 15 Preceptor development & support Requires protocols, theory-based instruction, practical application & ongoing dialogue Includes tools and components found within the Internship model/resources

16. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 16 Preceptor Development/Support raising the bar Preceptors as delivery agents Shape the culture of the workplace Nurture and support... or not Instruction related to teaching/learning Taught to foster Critical Thinking in others?

17. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 17 Preceptor Development Include updated role & responsibilities Protector role Evaluator – competency validation Instructional model - team approach Statewide, standardized, evidence-based Protocols to support role/expectations

18. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 18 Preceptor Preparation Role & Responsibilities Novice to Expert Adult Learning Theory Delegation/Liability Team Building and Group Dynamics Preceptor Toolkit New Graduates and competency assessment Personality Styles Communication Fostering Critical Thinking in the Novice Ongoing Preceptor Development and Support

19. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 19 VT Nurse Internship Project The Internship is a formal, post-licensure educational program designed to extend the basic nurse education preparation, proficiency, and/or skills of new graduate and transitioning nurses. Target audience - Interns are: LPN and RN new graduates Nurses in re-entry programs & those transitioning to a new specialty.

20. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 20 Internship Framework 10 weeks of experiential learning Starts after agency orientation 5 or less interns in a cohort (on one unit) Intern does not count in staffing mix 40 hours of didactic instruction provided 200 hours of clinical educator time Protocols and resources for intern & preceptor Preceptor development & identified time for teaching Clearly defined expectations (COPA model based) Clinical coaching plans (unit based teaching/learning plans)

21. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 21 Internship vs. Orientation The same framework and tools are applicable for ALL orientation and competency assessment of staff. The same competency assessment tools used for new graduates as for agency or traveling staff Theory-based frameworks that fit for all healthcare providers and departments

22. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 22 Core concepts Start with the end in mind Keep returning to that balancing point ROI - Return on investment Data collection – What is the evidence ? Preceptor development & support Clearly defined expectations Clinical Coaching Plans

23. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 23 Success equals: Completion Early identification that the person does not belong in the specialty Protection of client and staff member

24. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 24 Solutions for the 21 st Century Clearly defined expectations Clear expectations for novice & preceptor Includes program protocols & time to teach Preceptor development/support Delineate Protector and Evaluator roles Teach to foster C.T. skill development Provide clinical coaching plans Care plan for the novice Game plan for the preceptor Collaborative approach adds strength & quality

25. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 25 Return on Investment Precepting is a task Each task requires time for completion Quantifying time for precepting is required

26. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 26 Systems for finding time Reduce assignment by... Add clinical educator to unit for temporary assignment Specify unit for orientation – with staffing to accommodate

27. susan.boyer@hitchcock.org © 2001 Vermont Organization of Nurse Leaders (VONL) 27 Workplace Culture - environment of nurture & support Preceptor development and support Clinical Coaching Plan - Development of Critical Thinking Preceptors Interns Clearly defined expectations

28. Some key references: Alfaro-LeFevre, R. Critical Thinking and Clinical Judgment: A Practical Approach, 3rd Edition. © 2004 ISBN: 72169729 http://www.alfaroteachsmart.com Beecroft, P, Kunzman, L, Krozek, C. RN Internship – Outcomes of a One-Year Pilot Program; JONA; Vol 31, No.12, pp 575-582; December 2001 Benner, P. (1984). From Novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley. Boyer, S. Education -Practice Collaboration builds Internship and Preceptor Programs, Nursing Education Perspectives, Vol 23, No 2. Mar/Apr 2002 del Bueno, D. (2005) A Crisis in Critical Thinking. Nursing Education Perspectives, 26(5). 278-282. Lenburg, C. The Framework, concepts and methods of the competency outcomes and performance assessment (COPA) model. © 1999 Online Journal of Issues in Nursing. Sept. 30, 1999 http://nursingworld.org/ojin/topic10/tpc10_2.htm http://nursingworld.org/ojin/topic10/tpc10_2.htm A more extensive bibliography is available on the website: www.vnip.org www.vnip.org